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tv   Frontline  PBS  November 18, 2009 4:00pm-5:00pm EST

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>> fntline is made possible by contributns to your pbs ioom viewers le you. thanyou. with major funng fro thjohn d. and catherine t.acarthur foundation, commd to building more ju, verdant and peaceful world. anadditional funding from th rk foundation. committed to raising pubc ess. with aitional nding fo
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this progr from: ( sirens blaring ) >> tonighon frtline, the fure of americ heacare is at thcenterf a great te. how cathworld's st expensive medical syem, that leaves 47 million people out coverage and drives hundreds of thounds into bankruptcy each year, be reformed? >> the democrats nd to scrap all of these "big ment taoverf care" plans, hit the reset... iwod not be governmenru insurance. anit see we're all for choicentil one of the choices can be a plic option. >> the e result would be a deral government takeover of our health ce system, taking cit of the hds of doctors and tien. >> ratthanakg wild claims about goverent takeover of health car w
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should work togethero address y legimate concerns you may have. ( applse ) >> in the middle of our nional debate, washgton post reporter t.r. reidourneys to fintries... >> rd: have you ever paid a medical ll? >> no,ever. ...andinds out how other richree-market democracies pride alth care for all. >> reid: how many peop in swzerland go bankrupt becae of medical bls? >> nobody. doesn't happ. it would be huge scandal if it happens. >> tonit, in this ontline rebroadcast, whait like to be "sick arounthe world."
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>> reid: tt's the capitol the richest, most porful nationn history. but when it mes to providing health care for peop, that greacountry, our country, is a fourth-rate power. the wod heth organizatn says t us health care system rate37th in the rld in terms ofuality and fairness. all thother rich countries do better than do, and yethey spend a heckf a lot le. w do they do it? that's whathis film is about. we're gointoo around the world to see what ssons we can learn fix america's sick, sick health care system. i' covered the world as a foreign correspondent, andight now i'm writing a book abo health carsystems seas.
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firsst on my tour is great britain, wre our family lived for five years even thougthe uk is our closest ropean ally, its alth ce solution that is, the vernment-run national health service-- may seem to close to soclism for most aman still, we can len something here. for about half of what we pa per person, the nhcovers everybodand s mewh tter health isti, longer lifexptancower iant mortaly. britain's national healt servicis dicatedo the oposition that you should never have to pay medical bill. the nhs, there's no insuran premium,o co-pay, fee at l.
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the system covers evybody. and, you kno when we lived here, my family got really gd care from the nhs, althoh we often had to wait to see doctor. and yet thwspars here are full of nhrrortories-- raoning, waiting lists, terrible mistake so i've come to london to e th nhs. is it an answer for the u., or just some horrle socialist nanny state? the brits pafor health care out of taxevenue, so the governnt owns the hospitals, like this one, the whittgton hospital inorth london. the doctors who rk here are salaried gernment employees. does that sound like sialized mecine? well, accordinto the hpital ceo, david sloman, therits like it thay. >> i think peoe are proud of it. 90of people who use the nhs think it'sood or excellent. so people thinry, very highly o. pe whoon't use it, donl it, ac.
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>> r wldou say most british people go their wh lives and ner t a dica ll? >> every se person who's born in the will use the nhs at one point in their lives. the majorityf peop will use it as the only provir of tir medicacare annone of themill be prend a bill at any point ring that time. >> reid: ndical bills. sounds sweet tme. anhere's something else that's different: there's no mecal bankruptcy. th is jemy cadle. his son, tom, is being treed for leukemia athe whittington. at least he esn't have to rry about going bre. >> he's had ght weeks in hospital. aparfrom the times when he needs chemotherapywe've got mmunity heal carthat com in on a weeklyasis to take his bld. hasn't cost us a pny. yoknow, it's astonishing the care you can get. on your picture? reid: of cose, it's not free. the brits pamuchigher taxes an we do to cover heth car
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but even so, doeit sound a bit o good to be tru to find t, i sought out a longime nhs watcher, nigel hawkes of the imes," for more critical perspeiv look, this all sndreally sweet. >> ( ughs >> does itork? >> it works in some spects. i think imary care, the family emergency care works quiteod, well. ere i think it c fall down is on elective care-- hip replacements, art operations, this kind of thing. it useto be of the order of 18 months to gea new hip. that's been grtly reduced by the current governmentveth lasten years. it's down certainly less than six months, anfor most people abtwo or three. >> there are 400,000ewer people on waiting listthann 97. waing s...
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>> reid: in the last dece in britai tony blair d ot politicians have ruced t idt by spending more money and by bringing some market mechanisms to a government-r system. toy vernnt-owned hospitals like the whiington compete agnst each other for government money. in tay's n, patien can choose wch hospital to go to. >>h, of secompete. you know, do on our web site. we'll make sure you can ok into our place at leasas quick all the other places around re.he but we're l competinound whnk are now respect margins, whereas, previoly, yoknow, it was six months or seven months. no in some specialtii uld proctorrow. >> reid: is easy to sey choice might suients, t dgowhatrnment-run hpitals get out oft? we don undstand why people would compete en youan't make more money. in america, people cpete to make profit. >>es
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at's a verfair point. i meanhere you would compete in order to surv because ifoutart losing patients to anotr hospital, your services are gog to be under that. >>hat we've seen over the past ten years is a move awayrom bevin's ideal of an nhs for l. we've en the creeping privization of servis. >> reid: when i was in lonn, i stumbled othis rally in trafalgar square, d i diovered that many nhs staffers are ang abohese new trends that coulclose some of theess-popular hospitals. ey were also ptesting governnt plans to privatize some nhs servis. you' probably 50, or even more than that. ve you ever id aedal >>sn't he very kin >>eid: have you ever paid a medical bill? >> no, never. >>eid: will you ever pay a medical bill in yo life? i hnot.ope
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this is why 'rdoing this. on't want to. t arou, we d'tantrs time, if our ki to do it, eithe >> rd: while the hospitals struggle with reforms, the gps have embraced th. i we to sit one wh practices in theest london neighborhood of herds sh >> patcia wilton? yes. reid: in britain, health ca starts here. >> hi, have a seat. >>ei nobody can to go directly to a spst. fit you ve to go to gakeeper, ke dr. ahmed badat. >> ( coughing ) >> huh, a nasty cough. >> reid: hs a family docto a geral prtitioner. gps holdown costs for the stem and give people what th brits call "mecal me." myily d ju dowth street, and weed >> you'rgoing to he x-ray doneere. en your uth. >> reid: gps are paia fixed am based on the number of
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tients they have the ag is 1,800 people. d get thisthey make a bonus for keeping theipatits althy. so when . badat does a good job of caring for patits with diabetes and heartisease, he how much more?. >> it workout about £90,000. >> reid: so that'sncreasing your salary by180,000 a year. th's not bad. y, yes. >> reid: i'm reading the newspaper. it says docs a doing well here >> i can't comain. >> reid: dr. badat has had personal experiencwith u. medici he art attack while on vacation in las vegas, aas rush tthe co hpital. >> therement was absutely fantastic. but i was there eight days the total bi camto $,000. i mean, is eposterous.
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>> reid: ctics say britain has the opposi problem: care cts the patits too little here. twice a we or something?ome >> yes. ere's always like that. >> reid:re they sick, or... >> no. thintheye just lely ople, they a. so jt nt somebody to at to. t then there are people i nell. and they come d register, i don't sethem for tee years, five years >> reid: witaccesshis easy, the t system have strong incentive tepeople healthy. the sult: braihas become a world leader in prentive mecine ju look at all these servis gps here aggressely promote and talk to their patients about. to sum up, then, there's aot to like in britainno bills; nhs waiting lis are getting shorter; there's eelle prentive medicine.
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but there's probti tably s much governmt here for american tastes, even if t nhs is tg to be more market savvy. the next coury on my tour couldn't be more different our family livedhere twice. i was thtokyo correspondent for the "washiton st pan has 13million people. and whenever i ce to ts station in tokyo, i feelike every one of tm is right here. it's a ferociouslyitalist econ eye natal resou but they've built thsecond- richest country in theorld. and, y kno it's 130 million aly people. ey have tter national health than we do they cover everybody a-- g th-- thespend ha as much as the united stat on heth care p capit how do ty do that? one thing for certain: japaneseealth care is a bargai
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for just 8% of gdp that'less th even the brith end-- with fabulous heal stistics. they have the longest althy life expectancy in the worldnd the lowest infant mortality rate. now, pt of that's due to diet and lifestyle, but the heah systemusbe doing something right. everybody's covered, but unle the brits, t japanest pay for all of it through xes. instd, everybody has to sign upor a health insurance licy. yogeit at work othrough a counity-based rer. the governntks up the ta r thoswhare topoor. this systeis known as social inrance, and it's a model that's used in many alth countries. as for the health ca if, at's cerinly not socialist 80% of theospils are private,ore than in the u.s., d almost every doctor's offi dr. kono hitoshi is a tycal
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doctor. he runs a private -bed hospital in the tokyo neighborhood of soshigoya. the japanese arerodigious consumers of healtcare. they go tohe doctor the times as often as americando, and since there are gatekeeper they can go see any speciali they want. do you have to make an appointmt come? >> reid: ner? >> never. >> reid: how long do you s t >> three mines. >> reid: iseems like such a short visit.
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>> reid: surveys show e japanese are higy satisfied th their hlth system. >> ( speaking japane ) >> reid: excuse me. she says, "this annual psical is really a great idea. think that's why i've stayed healthy, because they reall look o for me and check out all my problems." >> ( speaking japanese ) >> reid: ( tranating ): well, it's not bad, as a matter of fact. you cat call it bad, because everyby has e insurance and the insunce pretty much takes care of e bills."
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>> ( spking japanese ) >> reid: " i think the japanese health careysm is real i knowothing about other countries. what do people in your coury think about yo health care system she says. here'something ee that's different: japanespatients haveuch longer hospital stays than amecans, and they love technology, like scans. they have nearly twice as ny mris per capita asmericans; eight tis as many as the brits. so how do th keep costs under contl? well, it turns out theapanese health ministry tightlcontrols thprice of healtcare right downo the smallest detai every two ars, the physicians and the heal ministry negoate a fixed price for every single produre and drug. like the items in is sushi erybar,ing from open heart surgery to a routine check-u has a standard pce, and this price the same everywhere in
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japan. if a doctor tries to boo his inme by incrsing the number ofrocedures, well, then, guess what theext negotiation,he governnt lowers the pric that's what ppened with mris, whare cribly cheap in japa i asked the country's top heth economist, prossor naoki ikegami,o tell us how that happened. denver, where i live, if yo get anri of your neck gion, it's $1,200. and the doctor we vited in japan says he gets98 for an mri. so how do yo tha >> well, in 2002, the govement sa that the mris, we are paying too mh. so in ordeto be within the total budget, we will cut em by 35%. >> reid: so, if i'm a door why don't i say, "we, i'm not going to dthem then, it's not engh money"? >> youorgot that we have only
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one paymensystem. so if yowant to do your mris, unless you canet private paying patients, which ialmost impossible in japan, y go out of business. >> reid: so that shafts the medical dece makers and must mit innovation, right? wellno. japase manufacturers of scanng equipment, like toshiba, found ways to me inexpensive maches they could se to doctors. and guess what? now ey're exporting these machines all over the rld. but pricregulation also hits the doctors hard. dr. ko can charge wh h wants. he can only charge what the official priceook dictates.
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>> reid: if somebo comes in th a cut that's less than si square inches-so, fairly small cut-- he gets 0 yen, $4.30, to sew that up. that's incredibly cheap. reid: he then told me what costs to sy in his hospital. okay, you'reoing to love this. so you kw how much it costs to spend the night a hospital here, according to this pric book? if you sy in a room with four people, ten dollara night. if you have a privatroom, $90 to spend the night ia hospital in a private rm here. that's because t government set the price. reid: is that fair? >> it's fair. >> reid: oh, iis.
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>> rei the doctors have to live with the ice book, but japaneseatients have to play their part ifincing the syst by paying into a social insurance fund. ifou lose your job in japan, you don't lose your alth insuranc unlikehe u.s., you switch to a community inrer, and these insunce companies have very little in common with their american counterparts. can they turn her wn if she has heart disease or somethi? >> that is forbidden. >> reid: the health care plans covering basic healtcare for a worker and his family,o they make a profit? >>o, because they. they are not allowed to make a prit, and anything lefover is rried over to the next year. and if there's aot carried over, thenhe premium rate would go down. >> reid: insuranceompanies barred from king a profit, national price regulatn--
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that'sll good news for patients e average premium for a japanese family is jus$280 a month, witthe employer paying ateast half, a lot less than most americans pay. it's good news for japanes employers as wl. j.r. tai, the company that runs this bull train to osaka, to me that its health costs are about half of 1% o operatg expenses. general moto pays eight times as much as tha so here's a untry with the longt life expectancy, cellent health resultsno iting lists and rock bottom costs. at's not to like? but the present of the nagoya central hospit, professor saito hidero, showed me e doside. >> i think our system is prey good, pretty goo but no system is perfect. >> reid: yes.
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>> but n 50% of hospitals are in financial deficit n. >> reid: no, iidn't know that. in japan? >> 50% in japan. so i'm afrd hospitals may be onof the endangered species in japan now. >> ah... >> reid: 50% in finaial deficit? th soundunsustainable. so here's the weakness. ile we spend too much on medicinethe japanese seem to spentoo little. in a country with ten doll per night hospital stays, the pres are just not hh enough to balance the books. but the japanese systeis so popular that they're not gng to rip iapart. the experts say theyl have to increase pris a ttle to save the hospals from going broke. back home, o problem is patits going broke. and in jap, how many people go bankru from medical costs? >> i don't know.
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( speakingapanese ) yeahalmost never hear , yeah >> rd: before leaving tokyo, i we to thmeiji jingu shrine, a deeply spiritual place. i left a prayer aski for somethini think almost all of us can agree o a heah system where, as japaneveryone gets carand nobody goes broke paying doctobills. nextto a country a bit more like the u., the nation that gave us pirin and x-rays, the third-chest economy in the world. it's gerny.
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in manways they' just like us, except, that is, for the healthare. that iing figure behind me is otto von bismarckthe prussian cncellor in the 1880s. and he's the guy w invented the concept ofealth care systems, the nion that a governnt has to provid mechanismso all its people can gemedical care when they need it. and today, the bismark mod is usedll over the world. thanks tthe bismarck model, everybody inermany is offered health care. whe the rich are allowed to opt out and pay ivately, about 90% of germans choosto stay in the national sysm. and th system is famous not only for covering l the basics-- plus mental healt ntal and optical-- they'll
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also payor alternative therapies like heopathy. they'll pay you to gto a spa. the system's even be known to cover belly ncing lessons. as in japan, the delivery health care is largely market affair cried out by private doors and private hospitals. i visited drchristina von koekri, a family doctor practicing in e small town of kladow, south of blin. if i call your office ansay, "oh, my shlder kind of hurts, i'm not sure wt's wrong," how would it take me to see you? >> o or twweeks. if it's seris, same day. >> reid: serious, sameay. if i come in here and you ok at my shoulder a say, "well, i think maybe an ohopedic speciast should look at it," then how lonwould i have wait to see the... it's different. perhapanother week or two. >> rei yeah. >> yes. >> reid:hat if the orthopedic specialist said, "wellweave
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to opete on your shoulder"? do you know how ng i would ha to wait for that? >> not too long. three weeks? >> reid: threeeeks before i could get in? >> i guess. >> reid: that'about the same iting time as the u.s. it's fastethan britain, bu not as quick as japan woulbe. to finan health care, germans pay emiums based on income to one of 240 pritensurers. they cl them "sickness funds." a worker earning $6000 would split a $7 monthly family premium with her emp it's more exnse than japan and the uk, but stl a bargain by u.s. andards, autwo- irds of ours. >> it is a system where the ch y for the poor, and where th ill are covered by the healt. >> reid: this is pfessor karl lauterbach, a mber of the gean parliament and one of germany's foremost eerts on health policy. >> so it is a nice socl
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support system which is ghly accept by the population. >> reid: katie haaseis one of those patients. she's having her third baby. >>'m very satisfied with the system, espeally during my pregnancy. i ink it's maybe not perfect, but 's the best i can imagine. >>eid: what does she pay? >> actuay, nothing. i dot have to pay anything. rd: whileregnant women pay nothing, tre is a coayment for mt patients. but you'll love this: it cos ten euros-- that about 15 bucks-- and you only have pay that onceverthree nths. if you lose ur job, what ppens to your health insurance? >>ealth inrance contues wi no change if you lose a job. we dknow very well that people
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who come unemployed are at an increased risk obecoming ill, and thereforbecoming employed is about the worst time to lose heah insurance. so therefore everyonwhlose a job mains in exactly the health insuran system he is >> reid: german insurae plans actively competemong themselvesor customers even though they are not alloweto make a profit. so what's in it fothem? >> sickness nds do not want to pesh. they want to survive a grow. d the management is better pa if the sickness fund is growing. so i think the germahealthre system is a nicehird way between for-profit system on the one hand and, let's say, single payer system onhe other hand. >> rd: it all sounds good to me, but how does the gern system compare with ours? to get a u.s. ew, i went to beican wseeen ling inrmer east
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germany fosix years. good to see you. haven't seen you sin kladow. >> it'been a while. wow, i lovthe new bar. it looks great. ( speaking german ) that's all the germai know. "i want a big beer >> thas all you need. ( laughter ) reid: you ever have to go t the doctor? i mean, you' used the health re system? >> o absolutely. reid: yeah. and what do u thin w uld you rate it? >> top notch. >> reid: oh,lly? how come? what's good? >> you have manyifferent choices, andhe cost is a fraction of what icovered in the stes. most of ur prescriptions are covered wi very, very small co-pays. >> reid: and how the quality? i mean, do you thinkoue gettingood health care here? >> excellent. tually, i see no difference, as far as quality es, tweenwas e states >> reid:eally?
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rveys show germa are satisfied with theirealth ca. the stem is also efficient. dical providers and sickness funds negotiate stanrd prices, and this cuts administtive costs. they're only aun6%. that's a quartf what they are in the u.s. and s e bargain here, too. >> the samdrugs e way cheaper in germany thain americ because,bviously, if all sickness funds negiate with thug companies for a sgle price, then the maet power of e sickness fundss fully used. >> rei every year the sickness funds also negotia standard prices wh medical providers. and just as in japan, so of these ctors feelndvalued and underpaid. professor detlevanten is chairmanf berlin's giant
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charité spital. so do you think yourospital is pa enough for the services it proves people? >> no. as mentioned, it not being paid enougbeuse we are providing veryxpsive care to university hpital, so we have to enomize enormously within the university stem also. >> rd: aeric hospital that ft it wasn't getting enough moneyor i svices would raits pres. could you dot? >> no, we nnot dthat. these prices are negotiate every year, and this idone by states. so, within bern, all the hospitals t the sa kind of drg re-compensation. we cannot raisour prices. >> rd: by u.s. standards, ctors who work in hospitals here are not paid very well. a 35-yr-old might earn about $80,000 a ar, about half what he'd earn inhe u.s. >> it's not a gh salary. and ople correctly complain cause they work not eight hours; they work 1hours, 1
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hour 16 hours, and sometimes seven days week. and i think they deser more. reid: dr. christi von koektz also feels shortchanged by t system. a family docr makes around $120,000 aear, about two- irds of what she'd earn in t s. but thenhe has a lot lower erhead. her malpracticpremium is just $1,400 a yr, about a tenth of what she would p in the u.s. and medical school didn't st her a penny. in ameri, we have an image of doctor as a pretty rich person. >> yes. >>eid: drives a lexus to the country club andakes vacations in majorca, and stf like that. >> it's been like is in germany til, i think, '80s, the '80s, the la century, perhaps '90s. but it's chang in the mid of 90 years, yes. >> rei okay. >>o you... a doctor normally has a small car toda but hetill goes to majorca.
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>>eid: still goes to majorca, yeah. skis in st mitz? >>o. ( laughter ) >> reid:ut a lot of doctors aren't laughg. in march of 2006they felt suiciently angry to stop work and take to the streets in t heart oferlin. drchristina was one of them. she marched thretimes that spri. >> ihink about 18,000 or 20,000 doctors, and ctors don't usually demonstrate. but nothing anged. >> reid: for americans the's nothing particully foreign about germanealth care. u get health insurance throu your eloyer and the company makes you pafor it. and the coverage is great. ey got mental, they got surgicalthey got dental. if your doctor says you're tired, the health inrance pays to send u to a spa. and the germans have madthis work. they provide universaloverage for a lot le money than we do.j$
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they d it by taking the profit out of heah insurance, and theylso pay doctors a lot less than wdo. i think there's a lot here tt we could learnrom. in just three countrie i've pickedp lots of ideas. the brits pay no doctobills d have great preventive care in japan, there's no wting time and doctors stillake use calls. in gerny, insurance mpanies compe for business even thou they can't make a prof. what if you could ck a choose the best ideas fr ound the world? well, that's ectly what one small asn nation did. n[i grt >> thank you. >> reid: taiwan's an iand nation of abou23 million that
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beca rapidly industrialized anwent from poor to rich in about 20 years. and when twan got rich, the government said, "wait a mine, we need rich country's health care system." so you know what they d? they set up a committeanthey looked all over the world rmño different heth care systems looking for good ideas, and then designed the own. in theate 1980s, taiwanese health care was en worse than america's is today. abouhalf the population had no hongn chang was one of the officials charged with digning a new health care system fm sctch. >> taiwan a small island. we always look abroa internatiolly for ideas. chinese saying: we say, "the track the previous cart is thteacher of the following cart." >>eid: so if the other guy's oxcart has found a gd route to universahealth coverage, follow those tcks. follow those tracks. ifhey were trapped in trouble,
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avoid that track. fi a new track. >> narrator: so they consult experts from around the worl and asked willm hsiao, a chinese-born harva health econist, to head a blue ribbon panel. >> why do you want to reat the mistakes other people ma? áüijkúu have done well and then mo bend that.4 >> reid: anotherxpert they consulted was iwanese american heal economist tsung-mei cheng. how many different couries did they look at, do you kno >> oveten. maybe n, 13, 15 countries they looked at. and so, the e, the program that they finally seup in 1995 really is like a car tt was made of differt parts, importedrom overseas but manufactured domescally. >> we examine quitextense the major systems of quite dozen-- europe, brish or
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france, germany d the nordic countrie swiss or the dutch or america. >> rei did you look at the richest country in the world, the united states? >> yes, yes, yes. it was the best system in th world, we thought. >> reid: yh, youhought. and when you studied it, wt did you find >> well, amerin is not really a syst that you can copy. it's a mart. so if yolet things happen it will be li the unitestates. there are many supporter but the end we said, "no, this is not the way we wanto go >> reid: they waed a system that gaveverybody equal access to health care, free choicof docts with no waiting time, and a system that couraged lots of competition amg medical priders. to financehe scheme, they chose a national insance systemhat forced everybody to join iand pay. but profesr hsiao thought taiwan could improve oother countries like japan a germany
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>> we trto correct their mistakes. japan has many funds. >> reid: yes. >> and wunified it. geany let the rich people opt out. we do not let the rich peopl opt out. so we're building on whathey have de correctly, but trying to overcome their ficiencies. >> reid: the solutn: to have one government insurer collecting t money and no chance to t out. the resulta system that works a bit like the u. medicare systemor the elderly, and, in facta lot like canada's. >> ihas drug benefits, vision care, traditional chinese medicine, kiey dialysis, inpaent care, outpatient care; just abo everything under the n. >> rd: and to satisfy the patients in taiwan, thers no gakeeper and no waiting times. clinics are en on weekends. this street clinicas bustling at 5:30 on a saturday afrnoon.
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if i woke up in taiwanome morning and my sulder is really hurting, holong would it take me to see an orthodic specialist? >> we goow. ( lahter ) >> reid: ts morning i could see one? >> yea >> reid: ion't have to go to a gp and get a recommendatio >> no, our people don't ke the idea of gatekeepers. they want to keethemselves... they wt to decide by themselves. >> reid: high-tech tain desied its new health system using state of the a information chnology. erybody here has to have a smart card like this to to the ctor. the doc puts it a reader and e patient's history, medicaons, et cetera, all show up on the screen and th the bill goes directly to the government surance office a is paid automacally. so taiwan has the lowest administrative costs iworld, less than 2%. compare at to the endless paperwork and all the nied
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clai we get with for-profit u.s. health insunce. thsmart card can also be used inther ways. >> if a tient goes to see a doctor or hospital over times a month, or 50 tes in a three- month period, then the ipicks that person out anthe person then gets a vit from the governnt, the bureau of national health insurae, and they have a ttle "chat." and this worksery well. >> reid: that may beoo much like big brother to get by i e u.s., but surveys show the taiwanese e highly satisfi with their heah care. reid: how many people in taiwanvery year go bankrupt becausof medical bills? >> non >> reid: so the paents are safe from baruptcy. but just like japa the system itself is under strain. >>eid: how much of the taiwan's gdp a you spending on health care?
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>> we spend me 6.23%. >> reid: and do you kn the number iamerica? yes, it's about 15%. >> reid: 16%, s, that's right. so we spend too mu on health care and don't even cover erybody. but the taiwanese spend o little, less even than jan. they just don't brg in enough money to p for all the services they offer. >> so actually, as we spk, the government iborrowing from banks toay what there isn't enough to pay the provider >> reid: taiwan's politians are reluctanto increase premms. they think voters will punish them. so that's their prlem. they know that the solution fairly straightforwa: increase the spending little to maybe 8% of gdp. now, tre's a problem the u.s. would love to have. like the other cntries we've seen, taiwan is ruggling to
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balance the hopes ofatients and the expectations odoctors ainst the price people are lling to pay for healtcare. before leaving twan i trie some acuncture for my bum should. i hurt it years ago in theavy. course, chinese medicine is covered by twan's plan, too. taiw's achievement got me inking abo what it takes to carrout health care reform. but to create a universahealth system ian emerging asian nation is one thg. to get there in mature free market economy is somethg else. so mfinal stop was in a untry more like us that did take on health care rerm. some people y it's politically impossle to fix a health care system. and, in fact, thlast time we tried it in 19, the result was
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distrous failure. but that same year here in itzerland, a country famous for huge insuran companies and drug cpanies, they did take on heal care reform and changed the system. todathey have universal coverage withigh quality. we've come to switzerlanto see y they made the change and h it working. like amerins, the swiss tend to think they're exceptial. they don follow the crowd. it's a nion of eight million peop right at the center of europe, but it won'toin the european union. it died women the vote until-- are you ready?-- 1971, and i s higher gun ownership than the u.a. in 1994,witzerland's health care system resembleamerica's. medical insurance was voluary, generally linked to employnt. if you lost yo job, you could lose your coverage, and ma did. ruth dreifuss ck then was
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health mister of the left- leing social democratic party, and later the firsfemale president ofhe swiss federation. she spearhded a new law called lama or the sickness. it mandated that erybody buy insurancwith the state paying fothe poor. in return, it guaraned a comprehensive package medical care for all. amid oppositiofrom drug companies and insurs the swiss voted in a referendu the difference between "yes and th"no" was a very tiny one, a very slight one and the resultas quite 50/50, just with a little b more on the "y" side so that the law was passed. >> reid: after that,nsurance companies could not cherry pk the young and althy to avoid e old and the sick. and they were t allowed to make a profit on basic car although they cod profit from supplement policies.
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people whoefused to get coverage were autotically assigned to an insurance company and had toay the monthly bills. more than ten yes later, lamal is welaccepted. pascal cchepin, from the center-right fe democratic party,s the current president of switzerland. originally unenthusiastiabout lamal, today he'a supporter. >> everybody has right to alth care. >> reid: yeah, now seethat's string for an amican. because weould certainly say everyone'sntitled to an education. >> yes >> everyone is entitleto legal protection if you t in trouble with the law. but we don't say that everyo's entitled thealth care. >> why? because it is profound need for people to be sure thatf they are strk by destiny, by a stroke of destiny, thecan have a good heah system? >> rd: dreifuss, from the
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opposite political cam agrees. >> i think is a basic human right. is is really the aim. and is is really the reason why i think that everybodyow, a rge, large majority, would renew e confidence in this system becse they see what it means to have a unersal coverage. >> rei but i wondered about lamal's impact on drug and insurance companies. pierre marcel vaz is ceo of groupe mutuel, onef switzerland's biggest inrance companies. what'sifferent here is that many swiss insurers were alrdy non-profit, so the trsformation was easier than it might be for us. ten years on the insurs are doing fine as in rmany, a lack of profit has not meant a lack of competition.
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>> rd: the benefit package here is fixed-- it's the se for evybody-- so companies compete in other way is this one of the ways yo compete with oth companies? you sa "we'll pay faster"? groupe mutuel has a stng inceive to keep administrative costs low. >> reid: do you know what at figure is in amerin health insuranccompanies? the avere administrative cost is about 22%, and yore running at 5%. but where the iss insurance companies can ma a profit is on supplemental covera for, say,etter hospital rooms. this is also how they atact more cusmers.
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but whatbout the drug companies? in america, the drug cpanies say, "well, if you cuthe price get for the drugs then we won't have as much mon for resear and innovation." is that a legitima argument? >> it was the me argument here in switzerland. >> reid: i'm sure. >> but i can say ao that the swiss phmaceutical industry ten years aftethis struggle is not bad. in the intnational competition i think e swiss are still benging to the top ten. anwhen you hear them, they are not crng about the bad shape of their industry. >> reid:hat may be because swiss drug companies stillake more tn a third of their profits from the less-gulated u.s. market. e of the problems we have in america is that many peoe, it's a he number of ople, go
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bankrupt because of medical bills. some sdies say 700,000 people a year. w many people in switzerland go bankrt because of medical bills? >> noby. doesn't happ. it would be a huge scandal iit haens. >> rd: but here's switzerland's challenge. havingchieved universal heal care, it has to dede how much citizens are willing to y. today an arage monthly premium for a swiss family is out $750 but ere's pressure to raise the emiums. and it's alrea the second most expensive health care stem in the world, altugh still much cheaper an ours. wh's interesting about switzerland is tt after lamaal's successpeople in this proud capilist country see limits now to the free marke cod a 100% free market system work in health care? >> no, i don't think so. if you do that, yowill lose solidari and equal access for
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everybody. >> reid:hich is what you were finding inhe late '80s. >> yes. we think that is aasic value of living inur society. >> my plan combines employs and individual resnsibility while mataining medicare and mecaid. i think thishole idea... >> reid: back in the u.s., ian election yea everybody's talking about health car >> my belief is that iwe make affordable, if we provide subsidies tohose who can't ford it, they will buy it. >> reid: although, iyou listen refully, none of the candidates tks about the leons we could learn from other rich democcies, like the ones i visited >>he solution, my friends, isn't a one size fits l, big governme takeover of health care. >> reid: what i've founds that
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it's not a socialized medicine out ther many couries provide universal covege with private insurance, prive doctors, private spitals, using market ideas that might work for us. t here's the thing. these capitalistountries don't trust alth care entirely to the free market. they all impose limits. there are three biones. first, insurance compaes must accept eveone and can't make a profit on basic care. second, evybody's mandated to buy insurance and e government pays the pmium for the poor. thir doctors and hospitals have to cept one standard set of fixedrices. caamericans accept ideas like that? >> just camen to get your tempature and your blood presre.
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>> reid: well, the facis these foreign healthare ideas aren't really sforeign to us. for erican veterans, health care is just like brain's nhs. for seniors on micare, we're taiwan. for working americans wi surance, we're germany. anfor the tens of million without health insurancewe're just another pr country. ( sirens blaring ) but almost all of us can aee thathis fragmented health care ss cannot be ignored. the longer we leave itthe sicker it becomes and the mo expensive the cure.
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>> this reporcontinues on our wesite, where you can watch thfull program again online. >>et this, they spend half as much... find out more about correspondt t.r. reid and his reporting of ts story. >> erybody has the right to alth care. >> read our intervis with some othe world's leading health ce experts. a for-profit system on the one hand a... >> and learn more aut how the u.s. hlth care system compares tthose in other countrie and thenoin the discussion about this proam at >> on frontline: in the aftermath of a disted electi... >> who was neda? why was e killed?
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>> woman'surder gave voice to aovement. >> she became symbol of all viims of the events. >> their cry s uploaded to the world. why did her death become th huge media event? >> can the movementontinue, and at what price? >> whore all of these other ople that have been killed? wh happened to them? "a death in tehran." watc frontline. >> frontline "sick around the world" is avlable on dvd. to order call pbs home veo at 1-800-pl-pbs. or order online at captioned by media cess group at wgbh >> fntline is made possible contributions to your pbs
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station from viewe like you. thank you. with major fundi from the john d. d catherine t. macarthur foundation, committed touilding a more ju, verdant and peaceful world. and adtional funding from the park foundation. with aitional funding for this program from: >> this is s.
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